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Residents passing through Allegheny General Hospital become well-rounded orthopaedic surgeons through clinical and didactic learning experiences.

 Clinical Experiences

For details of clinical experiences:

 Training Facilities

The main training facility is Allegheny General Hospital (AGH), a non-profit, Level 1 Trauma Center that is one of the largest tertiary care centers in the region.  AGH's surgical facilities include:

  • Main OR - The main operating room consists of 27 surgical suites. On any given day there are between 4 and 6 orthopaedic attending physicians operating. In general, each attending physician schedules 5 to 10 cases each operative day, not including trauma and add-ons.  Turnover time varies with the type of case but averages 30 to 45 minutes, allowing ample time for post-op checks, last minute reading, orders, consults, or lunch.
  • Outpatient Surgery Center - The Outpatient Surgery Center is a 7-suite surgery center located on the 01 level of AGH. Two to three orthopaedic attending physicians operate in the Outpatient Surgery Center daily, scheduling between 3 and 14 cases each. The main services utilizing the surgery center include hand, sports, and foot and ankle. Typical cases include arthroscopy, routine fracture care, carpal tunnel, etc.  Turnover time in the surgery center averages 10-15 minutes, allowing for efficient flow of operative cases.

Half of the pediatric orthopaedic rotation (3 months) is spent at Akron Children's Hospital, a 253-bed hospital located in downtown Akron, Ohio.  While at Akron, residents are provided a fully furnished 2-bedroom apartment that is fully paid for with monthly maid service, television, and Internet services as well as an in-unit washer and dryer. While at Akron, residents are regularly exposed to pediatric orthopaedic trauma as well as participating in the more advanced pediatric orthopaedic conditions that have been referred to Akron Children’s. Orthopaedic surgery residents from Akron General, Summa, Cleveland Clinic, and Affinity Health programs also rotate at Akron Children's Hospital.

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 Operative Experience

Residents training at Allegheny General Hospital become well-rounded orthopaedic surgeons as attested to by patients, fellowship directors, and faculty. The operative experience at AGH is extensive and begins during the 6-month orthopaedic rotation during PGY1. Early involvement in hands-on operative techniques allows the resident to refine and perfect his/her abilities over the 5-year program.

During the orthopaedic Internship, interns spend 6 months rotating through the orthopaedic service. Their duties include coverage during the day shift as well as night float to experience all aspects of orthopaedic trauma at a Level 1 trauma center. When on the orthopaedic pager rotation, the PGY1 resident is primarily responsible for managing emergency department and floor consults. While on the orthopaedic joints rotation, they spend their month mirroring the schedule of an adult reconstruction surgeon, assisting in the operating room and in clinic hours. During down time the interns are strongly encouraged and welcome to assist in the OR.

Case logs begin in PGY1. Residents leave the program with 1,800 to 2,500 procedures logged over the course of 4 years. Because of the attending-to-resident ratio, it is rare for more than one resident to be present in any one surgical case, but not uncommon for cases to go without resident coverage. This allows the resident to obtain a tremendous hands-on surgical experience.

 A Day in the Life
Intern Year

The Orthopaedic internship is run in coordination between the General Surgery department and the Orthopaedic department. It consists of 6 months of Orthopaedics and 6 months of General Surgery services. An intern year program takes place as lead by Dr. Mark Sangimino and takes place every Thursday throughout the year, even on nonorthopaedic rotations. The group will meet and discuss various orthopaedic pathologies, as well as the ins and outs of the operating room, use of the orthopaedic tables, casting, as well simulation testing which takes place throughout the year to adequately prepare interns for the upcoming orthopaedic years.

Orthopaedic months:

  • Pager – 3 months
  • Adult Reconstruction - 3 months

General Surgery months:

  • Emergency Department
  • Plastic Surgery
  • Vascular Surgery
  • Neurosurgery
  • Trauma ICU
  • Trauma night float

Ortho Pager:
The intern will hold the call pager for all ED consults, floor consults, and floor calls. Goals for the rotation include becoming proficient in evaluation of orthopaedic consults, learning about the various orthopaedic pathologies, formulation of a differential diagnosis, and skill in communication, evaluation, and management of orthopaedic patients.

Adult Reconstruction:
The remaining 3 months will be spent with an adult reconstruction surgeon in both the operating room and clinic. Goals will include developing a foundation for the field of adult reconstruction in the evaluation, diagnosis, and management of orthopaedic patients as well as a foundation for orthopaedic trauma.

Emergency Department:
The ED rotation is made up of 17-20 shifts over the month including both day and night shifts.  Goals for the rotation include exposure to various pathologies across the spectrum of medicine, management of acute patients, ability to manage patients from a medical standpoint.

Plastic Surgery:
Residents will typically take 2 weeks of hand surgery call while on service. Goals for the service include evaluation and management of soft tissue injuries as well as knowledge of available reconstruction options utilizing grafts and flaps.

Vascular Surgery:
Primary goals for the service are to become proficient in management of patients with vascular insufficiency, evaluation of acute vascular injury, as well as coordinated care with the orthopaedic surgery service.

This rotation is a hybrid of neurosurgery and orthopaedics, with an emphasis on spine. Interns will work with the spine surgeons within the Neurosurgery department, spending two days a week in the OR and one day a week in clinic. In addition, two days per week are free for working on research or for helping the Ortho Pager intern. Goals for the rotation are to become proficient in office evaluation of spine patients with various pathologies and become comfortable in operative management of spine cases.

Trauma ICU:
This ICU month exposes interns to the care of critically ill patients who sustain trauma. The service is made up of 3-4 residents from various departments. Goals of this service involve the management of patients that are critically ill, who may have injuries in multiple organ systems. This rotation allows orthopaedic interns a look at managing the patient not from an orthopaedic standpoint, but from an overall view to allow greater integration with other health care teams.

Trauma Nights:
Trauma night float duties include responding to all level 1 and 2 traumas along with a senior trauma resident, taking care of floor calls, and occasionally operating on emergency cases. Interns will be exposed to a variety of injury mechanisms including blunt and penetrating trauma, and will become proficient in the triage, evaluation, and management of trauma patients.

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 Call Schedule

The administrative chief resident is responsible for developing the call schedule. In-house call is covered by the “night float” resident (PGY2 ). PGY2 residents will each rotate through the night float rotation 6 weeks at a time for two rotations. The night float rotation is its own rotation so that the rotating resident is free from other responsibilities and consists of 5 night shifts (Sunday through Thursday) over the course of the week. Friday and Saturday night call is covered the on-call PGY2 or PGY3 resident.

A PGY4 or PGY5 resident will be available on a nightly basis as the back-up resident (home call). The back-up resident is available to answer routine questions from the junior residents, evaluate difficult patients, or operate as necessary.

Weekend rounds will be covered by on call residents and back up residents. The backup resident gains additional operative experience, is available in house to answer questions, and frees up the on call resident to handle emergency and floor responsibilities. If the on call resident is free to operate, they are encouraged to join the backup resident in the operating room.

Typically, each PGY2 resident is responsible for 6 weeks of night float as well as one Friday and one Saturday call a month. PGY4 and PGY5 call is composed of resident back up distributed evenly amongst all senior residents.

We maintain a 100% compliance policy with the 80-hour work-week as set forth by the ACGME. Clinical medicine is a time-consuming undertaking, and throughout our residency program, it is of the utmost importance to deliver quality care. Subsequently, we believe that residents should not be involved in direct patient care if their performance is impaired by fatigue. Resident work hours are limited to 80 hours per week averaged over the course of one month. At least one day in seven is free of academic and clinical responsibility, regardless of type of call. Hours worked by “back-up” call residents after being “called in” count toward the 80 hour work week. Residents are required to log all clinical hours to help monitor work hours.
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Daily Schedule

The schedule for any given day varies depending on the rotation schedule and the caseload. Some rotations lend themselves to a more hectic schedule than others (Trauma),  while other rotations contain a significantly larger clinical component. The schedule does vary slightly from class year to class year; however, such variations are minor and generally involve carrying the call pager during the day.

In general, the residents arrive at work around 5 a.m. and round until 6 a.m., at which time they attend the daily fracture conference until 6:30 a.m. At 6:30 a.m., all residents attend didactic lecture until 7 am. At 7:30 a.m., the first cases are being brought to the operating room and the operative day commences. Typically, there is enough time between cases to write orders, dictate, and eat, or brush up on upcoming cases.

Weekly Schedule

The following is a rundown of the weekly schedule for each rotation (subject to change):

Joints Senior
Office NGS
Office NGS/ Research
Joints Junior
Office JJS
Hand A
Office BAP
Hand B
Office PT
OR PT/ Office EB
Foot & Ankle
Office AW
Office VRP
Foot & Ankle Trauma/Research
AGH Pediatrics
Office MJS
OR SSJ/ MJS Office
OR MJS/ Research
Office SSJ
Sports Senior
OR PJD/ Research
Sports Junior
OR RES/ Research
Office DJP
Office DTA
Trauma Senior
Trauma Junior
Office EW
Joints Intern
Office T JS
Office T JS
Trauma pager

Annual Schedule

Please view the Rotation Schedule to see a sample annual schedule for all of our orthopaedic surgery residents.

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 Didactic Learning Experiences

 Morning Conference Schedule

  • Monday - Spine or Pediatrics every alternating week
  • Tuesday - Foot & Ankle/Biomechanics/Basic Science/Oncology
  • Wednesday - Upper Extremity Fracture Conference/Hand Topic Lecture
  • Thursday - Trauma or Adult Reconstruction every alternating week
  • Friday - Sports

Attendance at lectures is mandatory except in the event of an emergency. All residents are expected to  participate in conferences from 6 to 7:30 a.m. daily (except on Tuesday, when the conference runs until 8 a.m.). This begins with fracture conference daily from 6 to 6:30 a.m. Specialty conferences follow from 6:30 to 7:30 a.m.

Regular conferences run from September through May. Methods of teaching will include didactic lecture for a majority of conferences, with interspersed sawbones, cadaver dissection and arthroscopy labs. A resident will lead conferences with an attending physician present.

The conference schedule in July and August is made up of a summer lecture review series. This is a comprehensive lecture series aimed at reviewing the basics of the orthopedic history and physical exam, X-rays, anatomy and basic operative skills.

Morbidity and mortality conference occurs on one Tuesday every month preceding grand rounds. The resident involved in the index procedure/initial case is responsible for presenting the complication. 

Journal Club occurs on a monthly basis and is specialty specific.

Sample monthly educational curriculum

 2016-2017 Visiting Professors

Mark J. Berkowitz, MD
Director, Foot and Ankle Fellowship, Director, Foot and Ankle Center
Cleveland Clinic, Cleveland, OH

Mitchell Bernstein, MD, FRCSC
Assistant Professor, Orthopaedic Trauma and Limb Deformity
Department of Orthopaedic Surgery and Rehabilitation
Loyola University Chicago, Stritch School of Medicine
Chicago, IL

Peter J. Evans, MD, PhD, FACS (C)
Director, Cleveland Clinic Upper Extremity Center
Director, Cleveland Combined Hand Fellowship
Director, Cleveland Clinic Peripheral Nerve Center
Cleveland Clinic
Cleveland, OH

Mark C. Gebhardt, MD
Professor, Frederick W. and Jane M. Ilfeld Musculoskeletal Oncology
Harvard Medical School
Boston, MA

John G. Ginnetti, MD
Assistant Professor, Adult Reconstruction Division
University of Rochester, Department of Orthopaedic Surgery and Rehabilitation
Rochester, NY

John France, MD
Orthopaedic Spine Surgery
Chief, Spine Service
Professor and Vice Chairman, Orthopaedics
Ruby Memorial Hospital
Morgantown, WV

William G. Hamilton, MD
Anderson Orthopaedic Clinic
Alexandria, VA

Todd Ritzman, MD
Pediatric Orthopaedic Surgery
Akron Children’s Hospital
Akron, OH

Scott Weiner, MD
Pediatric Orthopaedic Surgery
Akron Children’s Hospital
Akron, OH